Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pleural Disease (Pleural Effusion (Exam findings (Decreased tactile…
Pleural Disease
Pleural Effusion
Exam findings
Decreased tactile fremitus
Decreased breath sounds
Dullness to percussion
Increased breath sounds @ SUPERIOR border of fluid collection
Pleural rub
Changes in appearance of hemithorax
Confirm dx -- CXR, Chest CT, US, PFTs
History
Duration
Previous pneumonia or pleurisy
S/p CABG surgery? (? harvest int. mammary arteries)
S/p radiation?
Asbestos?
Hx travel, residence (fungal exposure)
Drugs
Amiodarone
B-blocker
MTX
Nitrofurantoin
Phenytoin
Diagnostics
Thoracentesis (unless <10 mm layering or <250 mL, or if CHF w/ some exceptions)
Parapneumonic effusion
Assoc w/ acute pneumonia
Empyema = pus in pleural space
Indications for chest tube drainage
Frank pus
(+) PF gram stain
(+) PF culture
PF pH <7.0
Rx: ABX +/- chest tube
Chylothorax
Fluid: White, opaque
Labs: Triglycerides >110
Transudate vs. Exudate
Transudate
Causes (by organ) = heart, liver, kidney
Fluid: Decr protein
TREAT UNDERLYING CAUSE
Most common:
CHF
w/ systemic venous HTN,
cirrhosis
, peritoneal dialysis, urinothorax,
nephrotic synd.
, atelectasis
From altered mvmt of fluid in/out of pleural space w/ net accumulation (incr hydrostatic press, decr oncotic press)
Exudate
PF glucose = 0 mg/dL + PF pH <7.3 --> Chronic rheum. pleurisy, empyema, paragonimiasis
PF glucose <60 mg/dL + PF pH <7.3 --> Hemothorax, Churg-Strauss
PF
Glucose <60 mg/dL
= increased cell metabolism = active inflammation -->
Malignancy, Infection, RA
Fluid: ^ protein, cloudy
Common causes:
Infection
(bacterial, mycobacterial),
malignancy
(metastatic, mesothelioma), collagen vascular disease, trauma (states of ^ vasc permeability).
Light Criteria
PF/Serum LDH ratio >0.6
PF/Serum Protein ratio >0.5
PF LDH > 2/3 upper nl limit for serum LDH (~170)
From disease/irritation of pleural surface (pleural inflammation, incr vascular permeability, impaired lymphatic drainage)
Lymphocytic Exudative PF: TB effusion, chylothorax, lymphoma, chronic rheum. pleurisy, sarcoidosis, post-CABG (>2 mo), acute lung rejection
Eosinophilic Exudative PF: pneumothorax, hemothorax, BAPE, PE, parasitic, fungal, drug-induced, carcinoma, Churg-Strauss, lymphoma (Hodgkin), TB pleurisy